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Paeds & Superficial (MIDS 227) > Thyroid Pathology (Unit 2B) + TIRADS (Unit 4) > Flashcards

Thyroid Pathology (Unit 2B) + TIRADS (Unit 4) Flashcards

1
Q

What are examples of diffuse pathology of the thyroid gland? (3)

A

Inflammatory/infectious
Thyroditis
Autoimmune

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2
Q

What are examples over focal pathology of the thyroid gland? (6)

A

Nodules (single/multiple)
Hyperplasia
Adenoma
Carcinoma
Lymphoma
Mets

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3
Q

What is Euthyroid?

A

Normal functioning thyroid gland

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4
Q

What is Thyrotoxicosis/Hyperthyroidism caused by?

A

Elevated levels of free T3 and T4 = causes a hypermetabolic state

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5
Q

What is the difference between Primary Hyperthyroidism and Secondary Hypterthyrodism?

A

Primary - excess thyroid hormone is synthesized and secretes by the thyroid gland
Secondary - caused by outside source

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6
Q

What is the most common cause of hyperthyroidism?

A

Graves Disease (autoimmune disease)

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7
Q

What are the symptoms of hyperthyroidism/thyrotoxicosis?

A
  1. Hyperthyroidism
  2. Diffuse thyroid enlargement (goiter)
  3. Ophthalmopathy (protrusion of the eyes)
  4. Graves dermopathy (pretibial myxedema)
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8
Q

What are the clinical manifestations of Hyperthyroidism?

A
  • Weight Loss (unintentional, severe)
  • Excessive sweating
  • Heat intolerance
  • Ophthalmopathy (bulging eyes)
  • Enlarged thyroid (goiter)
  • Tachycardia at rest
  • Mood changes
  • Dyspnea
  • Nervousness
  • Hand Tremors/Muscular weakness
  • Menstrual irregularities (Oligomenorrhea or
    amenorrhea)
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9
Q

What is a Thyroid Storm?

A

Increased HR, BP, and body temperature all to extreme degrees

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10
Q

What are the symptoms of children who have hyperthyroidism?

A
  • accelerated growth spurts and advanced bone age
  • emotional lability
  • hyperactivity
  • difficulty concentrating
  • occasionally failure to thrive
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11
Q

What is the sonographic appearance of Hyperthyroidism/Grave’s Disease?

A
  • normal or enlarged
  • heterogenous (when enlarged)
  • hypervascularity
  • peak velocities exceeding 70 cm/sec)
  • diffuse enlargement of isthmus >1cm
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12
Q

What are 5 symptoms of Thyroiditis?

A
  • Dysphagia
  • Pain radiating to ear
  • Thyroid gland visibly enlarged on one side
  • Tender pretracheal lymph nodes
  • Thyroid gland = tender, palpable
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13
Q

What is the presentation for acute Thyroiditis?

A

Low grade fever & sore neck

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14
Q

What is subacute thyroiditis also called?

A

De Quervain Disease or Granulomatous Thyroiditis

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15
Q

What is the clinical presentation of Subacute Thyroiditis?

A
  • Hx of recent viral infection
  • Neck pain which can radiate to upper jaw, throat or ears. Associated with other
    symptoms of inflammation (fever, tenderness, fatigue, etc)
  • Unilateral or bilateral enlargement of gland
  • Usually temporary, resolves in 2-6 weeks with spontaneous recovery of thyroid function
    in 6-8 weeks
  • Good recovery, may have some residual fibrosis
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16
Q

What does Subacute Thyroiditis look like on US?

A
  • Enlargement
  • Hypoechoic
  • Normal or decreased vascularity
  • Nodularity
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17
Q

What is the most common thyroid function disorder?

A

Hypothyroidism

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18
Q

What is secondary (central) hypothyroidism?

A
  • Pituitary or hypothalamus failing to stimulate normal thyroid function
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19
Q

What is the most common cause of primary hypothyroidism?

A

chronic autoimmune thyroiditis (aka Hashimoto thyroiditis)

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20
Q

Describe the clinical relevance of Primary Hypothyroidism.

A
  • Peak incidence: 45 and 65 years of age
  • Females > Males
  • Associated with genetic predisposition, high iodine intake, selenium deficiency,
    smoking, and chronic hepatitis C
  • Associated with other autoimmune disease (Sjögren syndrome, lupus,
    rheumatoid arthritis)
  • Diagnosed clinically with blood work
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21
Q

What are the key clinical manifestations of hypothyroidism?

A
  • weakness/fatigue
  • dry skin
  • cold intolerance
  • hoarseness
  • weight gain
  • constipation
  • menstrual irregularities
  • decreased sweating
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22
Q

Hasimoto’s Thyroiditis can appear like which other Thyroid issue in US?

A

Graves disease
- abnormal echotexture
- often hypervascular

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23
Q

Describe the appearance of the 3 stages of Hashimoto’s Thyroiditis.

A

Early: increased size, coarse echotexture, hypo to normal echogenicity
Late: fibrotic strands cause lobulations
Even later: Multinodular, heterogenous, with multiple small hypoechoic nodules throughout, can appear ill defined and atrophic

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24
Q

What is a common measurement of the isthmus to suggest a goiter?

A

Greater than 1cm

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25
Q

What are the symptoms associated with goiters? DIVH

A
  • Dysphagia
  • Inspiratory stridor
  • Venous congestion
  • Hoarseness
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26
Q

An endemic non toxic goiter is due to an iodine deficiency in food/water/soil in a given area - what happens to the thyroid?

A

Hypothyroid (decrease in iodine, decrease in T3/4, INCREASE in TSH)

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27
Q

Toxic goiters are typically what and induce what?

A

Multinodular, can induce hyperthyroidism, thyrotoxicosis, graves disease

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28
Q

Multi-lobulated goiters are enlarged in which way? Symmetrical or asymmetrical?

A

Asymmetrical

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29
Q

What is a plunging goiter?

A

When one or both lobes extend below the clavicle or sternum

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30
Q

What is the sonographic appearance of a multinodular goiters?

A
  • Heterogeneous
  • Lobulated, multinodular
  • Possible calcifications
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31
Q

In multinodular goiters what is it important to look for?

A

Important to look for other discrete nodules within the goiter as neoplasms and cancers can exist within a goiter

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32
Q

What commonly happens to the thyroid and pregnancy?

A

Enlarges due to reduction in plasma idoine

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33
Q

What is the most common thyroid condition after abortion/miscarriage/delivery?

A

Postpartum Thyroiditis (PPT)

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34
Q

What is the clinical presentation and sonographic appearance of postpartum thyroiditis?

A
  • Classic presentation: thyrotoxicosis followed by hypothyroidism
  • Sono appearance: ↓ echogenicity, diffuse enlargement of thyroid (non specific)
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35
Q

What causes the majority of nodular diseases in the thyroid?

A

Hyperplasia

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36
Q

A nontoxic goiter is typically: euthyroid, hyperthyroid, hypothyroid?

A

Euthyroid

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37
Q

Hyperplasia in thyroids occur due to?

A

Iodine deficiency or under utilization

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38
Q

What is the most common sonographic appearance of hyplerplasia?

A

Isoechoic
Can also have: peripheral halo, cystic degeneration, perinodular vascularity

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39
Q

What is the treatment for benign thyroid cysts?

A

Percutaneous ethanol injection

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40
Q

What are the 2 types of thyroid cysts?

A

Simple, complex

41
Q

What are the 2 types of complex cysts?

A

Colloid, hemorrhagic

42
Q

What does a simple thyroid cyst look like on ultrasound?

A
  • Typically circular/oval
  • Distinct margins
  • No internal echoes
  • Posterior enhancement
43
Q

What does a colloid thyroid cyst look like on ultrasound?

A
  • Very common
  • Irregularly enlarged follicles containing abundant
    colloid
  • Can have calcifications
  • May have multiple echogenic foci (colloid crystals)
    with comet tail artifact (not to be confused with
    microcalcifications)
44
Q

What does a hemorrhagic thyroid cyst look like on ultrasound?

A
  • May contain blood and debris
  • May have complex internal echoes, septa, debris
    (layered debris @ dependent portion is highly
    characteristic of hemorrhage)
45
Q

What does a Hot Thyroid Nodule look like on a technetium-99m (Tc-99m) Nuclear Medicine
scintigraphy examination?

A

(hyper-functioning/autonomous). Area of dense collection of activity on nuclear
med image

46
Q

Does a hot thyroid nodule on a nuc med test indicate malignancy?

A

No, typically benign

47
Q

What does a Cold Thyroid Nodule look like on a technetium-99m (Tc-99m) Nuclear Medicine
scintigraphy examination?

A

(non-functioning). Area of decreased/absent activity on nuclear med image

48
Q

Of hot or cold thyroid nodules on a nuc med test, which is to be more concerned with malignancy?

A

Cold

49
Q

Most Thyroid Adenomas come from which histological subtype?

A

Follicular cells

50
Q

The majority of Thyroid Adenomas are non functioning (cold) or functioning (hot)?

A

Non functioning (cold)

51
Q

A toxic adenoma does what?

A

Produces thyroid hormone and causes hyperthyroidism

52
Q

How large can a thyroid adenoma be?

A

> 2.5 - 3.0cm

53
Q

What is the most common sonographic appearance for a thyroid adenoma?

A

Solitary, well circumscribed, oval/circular

54
Q

What is the colour doppler appearance for a thyroid adenoma look like?

A

Spoke & wheel

55
Q

What is the most common type of thyroid cancer?

A

Papillary (75-85%)

56
Q

What is the second most common type of thyroid cancer?

A

Follicular (10-20%)

57
Q

What is needed to confirm a thyroid carcinoma malignancy?

A

FNA/biopsy

58
Q

What is one of the most specific features of malignancy in a thyroid carcinoma?

A

Microcalcifications (<2mm)

59
Q

Are thyroid carcinomas hypoechoic or hyperechoic?

A

hypoechoic

60
Q

What is associated with INCREASED thyroid cancer risk?
HEMIIISLE

A
  • hypoechogenicity
  • entirely solid
  • microcalcifications
  • intrinsic hypervascularity (central part)
  • incomplete or absent halo
  • ill-defined margin
  • shape: tall > wide
  • local invasion of lymphadenopathy
  • eleasticity indication of increased tissue stiffness compared to normal tissue
61
Q

What is associated with LOW thyroid cancer risk?
HCLEPI

A
  • hyperechoic or isoechoic
  • cystic elements
  • large, coarse calficiations (except medullary thyroid cancer)
  • eggshell calcifications
  • perinodular hypervascularity or avascular node
  • inspissated colloid; comet-tail shadowing
62
Q

What is the least aggressive and best prognosis thyroid cancer?

A

Papillary

63
Q

How doe papillary carcinoma spread?

A

Via lymphatics

64
Q

What is the clinical presentation of Papillary Carcinoma?

A
  • Painless palpable lump
  • Palpable nodule with enlarged cervical lymph nodes
  • Enlarged cervical lymph nodes without palpable thyroid nodule
65
Q

What is the most accurate way to get a diagnosis for Papillary Carcinoma?

A

FNA biopsy

66
Q

What are the treatment options for Papillary Carcinoma?

A

Variable. Total or partial thyroidectomy, radical neck dissection. Usually followed by suppressive therapy

67
Q

What is the sonographic appearance of Papillary Carcinoma?
HMHP

A
  • Hypoechogenicity**
  • Microcalcifications*
  • Hypervascularity with disorganized vessels
  • Punctate microcalcifications may appear in the affected lymph nodes if metastasis is present
68
Q

How does follicular carcinoma spread?

A

Hematological spread

69
Q

What is the clinical presentation of follicular carcinoma?

A
  • Slow growing, painless nodule
  • Mets to bone, lungs or liver is seen with this type
70
Q

What is the most accurate way to get a diagnosis for Follicular Carcinoma?

A

Histologically

71
Q

What are the treatment options for Follicular Carcinoma?

A
  • lobectomy or thyroidectomy
  • Widely invasive tumors are usually followed by radioactive iodine treatment
72
Q

What type of carcinoma/adenoma CANNOT be distinguished on sonography or with FNA?

A

Follicular

73
Q

What is the sonographic appearance of Follicular Carcinoma?

A

Appearances overlap with follicular adenomas
Can sometimes have features of malignancy (although rarely):
- Irregular margins
- Thick irregular halo
- Hypervascularity

74
Q

Medullary Carcinoma is derived from which types of cells? And what do they secrete?

A

Parafollicular cells (c-cells) - secrete calcitonin

75
Q

What serum increases with Medullary Caricnoma?

A

Serum calcitonin

76
Q

What type of carcinoma is associated with MEN syndrome?

A

Medullary

77
Q

What is the clinical presentation of Medullary Carcinoma?

A

Clinical Presentation:
- Mass in the neck (can cause dysphagia or hoarsenes)
- Patients often suffer a number of symptoms related to endocrine secretion (including carcinoid
syndrome (serotonin) and Cushing syndrome)

78
Q

What is the sonographic appearance of Medullary Carcinoma?

A

Sonographic Appearances:
- Similar to papillary carcinoma (local invasion & metastasis to cervical lymph nodes is more often in
patients with medullary carcinoma)

79
Q

What is an aggressive and poor prognosis carcinoma?

A

Anaplastic Thyroid Carcinoma

80
Q

What is the clinical appearance of Anaplastic Thyroid Carcinoma?

A
  • Rapidly enlarging neck mass with symptoms relating to the destruction of local structures (dyspnea,
    dysphagia, hoarseness, cough)
81
Q

What is the sonographic appearance of Anaplastic Thyroid Carcinoma?

A
  • Large, solid, hypoechoic mass with demonstration of encasing or invading blood vessels and possible
    invasion of other nearby structures
  • Difficult to assess due to size, ultrasound usually inadequate to assess the extent/invasion (CT or MRI is
    better)
82
Q

What type of Carcinoma is more popular in men?

A

Hurthle Cell Carcinoma

83
Q

What type of cells does Hurthle Cell Carcinoma produce?

A

Thyroglobulin

84
Q

How do you classify Hurthle Cell Carcinoma as benign or malignant?

A

Histology

85
Q

What is the clinical presentation of Thyroid Lymphoma?

A
  • Most arise in the setting of chronic thyroiditis (Hashimoto)
  • Rapidly growing mass
  • Symptoms of airway obstruction (dyspnea, dysphagia)
86
Q

What is the sonographic appearance of Thyroid Lymphoma?

A
  • Large, solid, hypoechoic mass
  • Infiltration of thyroid parenchyma and even encasement of neck vessels (CCA, IJV)
  • Cystic necrosis
  • Doppler: nonspecific. Hypovascular or chaotic blood vessel distribution
87
Q

How is thyroid mets most commonly spread?

A

By blood

88
Q

What is the sonographic appearance of lymphadenopathy?

A
  • Round
  • Hypoechoic
  • Absence of fatty hilum
  • Cystic necrosis within
  • Increasing size (esp on serial exams, and with mets)
  • Mixed / chaotic vascularity
  • Mets from PTC – calcifications in the nodes is common and lymph node appears hyperechoic
89
Q

How large are macro-calcifications defined as in the thyroid with TIRADS ?

A

Greater than or equal to 2mm

90
Q

Echogenic foci _____mm, occcasionally can have comet tail _____mm.

A

<2
<1

91
Q

When do you not use TR descriptors for nodules?

A

Under 5mm

92
Q

If rim calcifications obscure the nodule, what do you choose the composition to be?

A

Solid

93
Q

If rim calcifications obscure the nodule, what do you choose the echogenicity to be?

A

isoechoic

94
Q

If the margin cannot be determined in a thyroid nodule, how do you describe the borders in TIRADS?

A

ill-defined

95
Q

If the echogenicity cannot be determined in a thyroid nodule, how do you describe the echogenicity in TIRADS?

A

isoechoic

96
Q

If the composition cannot be determined in a thyroid nodule, how do you describe the composition in TIRADS?

A

solid

97
Q

When do you stop further characterization of a nodule in TIRADS?

A

If it is spongiform and identified as TRI

98
Q

What are the 2 biggest limitations of FNA?

A
  1. Lacks specificity for certain cancers (Follicular carcinoma, Hurthle cell carcinoma, and lymphomas)
  2. Inconclusive results are common, often need repeating

Paeds & Superficial (MIDS 227) (12 decks)

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